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Observational Study
. 2024 Oct:122:177-184.
doi: 10.1016/j.sleep.2024.08.018. Epub 2024 Aug 20.

Multidimensional prediction of continuous positive airway pressure adherence

Eriko Hamada  1 , Motoo Yamauchi  2 , Yukio Fujita  1 , Tsuguo Nishijima  3 , Azusa Ikegami  4 , Toshio Takaoka  5 , Ryutaro Shirahama  6 , Kingman P Strohl  7 , Shigeo Muro  1
Affiliations
Observational Study

Multidimensional prediction of continuous positive airway pressure adherence

Eriko Hamada et al. Sleep Med. 2024 Oct.

Abstract

Objective: Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA). Unsatisfactory adherence to CPAP is an important clinical issue to resolve. Cluster analysis is a powerful tool to distinguish subgroups in a multidimensional fashion. This study aimed to investigate the use of cluster analysis for predicting CPAP adherence using clinical polysomnographic (PSG) parameters and patient characteristics.

Patients/methods: Participants of this multicenter observational study were 1133 patients with OSA who were newly diagnosed and implemented CPAP. Ward's method of cluster analysis was applied to in-laboratory diagnostic PSG parameters and patient characteristics. CPAP adherence was assessed during 90- and 365-day periods after CPAP initiation in each cluster. We adopted the Centers for Medicare and Medicaid Services criterion for CPAP adherence, i.e., CPAP use ≥4 h per night for 70 % or more of the observation period. Logistic regression analysis was performed to stratify clusters according to CPAP adherence.

Results: Five clusters were identified through cluster analysis. Clustering was significantly associated with CPAP adherence at 90- and 365-day periods after CPAP initiation. Logistic regression revealed that the cluster with features including apnea predominant sleep-disordered breathing, high apnea-hypopnea index, and relatively older age demonstrated the highest CPAP adherence.

Conclusion: Cluster analysis revealed hidden connections using patient characteristics and PSG parameters to successfully identify patients more likely to adhere to CPAP for 90 days and up to 365 days. When prescribing CPAP, it is possible to identify patients with OSA who are more likely to be non-adherent.

Keywords: CPAP adherence; Cluster analysis; Obstructive sleep apnea; Prediction of CPAP adherence.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Eriko Hamada reports statistical analysis was provided by ClinChoice Inc. Motoo Yamauchi reports statistical analysis was provided by ClinChoice Inc. Motoo Yamauchi reports a relationship with Sanofi that includes: funding grants. Motoo Yamauchi reports a relationship with Koike Medical Co Ltd that includes: funding grants. Motoo Yamauchi reports a relationship with Murata Manufacturing Co Ltd that includes: consulting or advisory. Motoo Yamauchi reports a relationship with Inspire Medical Systems Inc that includes: consulting or advisory. Azusa Ikegami reports a relationship with Esai Corp that includes: funding grants and speaking and lecture fees. Azusa Ikegami reports a relationship with MSD Corp that includes: funding grants and speaking and lecture fees. Azusa Ikegami reports a relationship with AstraZeneca Corp that includes: funding grants and speaking and lecture fees. Azusa Ikegami reports a relationship with ResMed KK that includes: consulting or advisory. Toshio Takaoka reports a relationship with ResMed KK that includes: consulting or advisory. Ryutaro Shirahama reports a relationship with Sony Music Entertainment Inc that includes: consulting or advisory. Ryutaro Shirahama reports a relationship with XEBIO Holdings Co. that includes: consulting or advisory. Ryutaro Shirahama reports a relationship with Lifenrich. Co. that includes: consulting or advisory. Ryutaro Shirahama reports a relationship with Zone Co Ltd that includes: consulting or advisory. Ryutaro Shirahama reports a relationship with MTG Co Ltd that includes: consulting or advisory and funding grants. Ryutaro Shirahama reports a relationship with Takeda Pharmaceutical Company Limited that includes: speaking and lecture fees. Kingman P Strohl reports a relationship with National Institutes of Health that includes: funding grants. Kingman P Strohl reports a relationship with Anemed oral appliance Local PI that includes: funding grants. Kingman P Strohl reports a relationship with Sommetrics LLC that includes: funding grants. Kingman P Strohl reports a relationship with Up-to-Date that includes: consulting or advisory. Kingman P Strohl reports a relationship with Medscape that includes: consulting or advisory. Kingman P Strohl reports a relationship with Merck Manual Professional and Consumer that includes: consulting or advisory. Kingman P Strohl reports a relationship with Sleep Ahead (post-stroke) Medical Adjudicator that includes: consulting or advisory. Shigeo Muro reports a relationship with Chugai Pharmaceutical Co Ltd that includes: funding grants. Shigeo Muro reports a relationship with Rohto Pharmaceutical Co Ltd that includes: funding grants. Shigeo Muro reports a relationship with Kintetsu Cable Network Co Ltd that includes: funding grants. Shigeo Muro reports a relationship with Nippon Boehringer Ingelheim Co Ltd that includes: consulting or advisory. Shigeo Muro reports a relationship with Novartis Pharma Japan that includes: consulting or advisory. Shigeo Muro reports a relationship with GSK Japan that includes: consulting or advisory. Shigeo Muro reports a relationship with AstraZeneca Japan that includes: consulting or advisory. Shigeo Muro reports a relationship with Teijin Pharma Limited that includes: consulting or advisory. Shigeo Muro reports a relationship with Janssen Pharmaceutical KK that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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